Epidural Blood Patches Performed with Miethke Sensor Reservoir for Continuous Intracranial Pressure Monitoring

An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.

Recent advances in electronic devices for monitoring and modulation of brain

The brain is actuated by billions of neurons with trillions of interconnections that regulate human behaviors.Understanding the mechanisms of these systems that induce sensory reactions and respond to disease remains one of the greatest challenges in science,engineering,and medicine.Recent advances in nanomaterials and nanotechnologies have led to the extensive research of electronic devices for brain interfaces to better understand the neural activities of the brains complex nervous system.The development of sensor devices for monitoring the physiological signals of the brain related to traumatic injury status has accompanied by the progress of electronic neural probes in parallel.In addition,these neurological and stereotactic surgical revolutions hold immense potential for clinical analysis of pharmacological systems within cerebral tissues.Here,we review the progress of electronic devices interfacing with brain in terms of the materials,fabrication technologies,and device designs.Neurophysiological activity can be measured and modulated by brain probes based on newly developed nanofabrication methodologies.Furthermore,in vivo pathological monitoring of the brain and pharmacological assessment has been developed in miniaturized and wireless form.We also consider the key challenges and prospects for further development,and explore the future directions emerging in the latest research.

Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit

BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the bedside.It has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the guidelines.However,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.METHODS PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP.Studies from 2010 to 2024 in English languages were included.RESULTS We found 37 articles relevant to our search.The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm.Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter.ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial infection.However,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid haemorrhage.CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.